Honeymoon is over

[klmno]

He's already cut himself and come begging and freaking out for cigs. I told him no, then he started trying to search my pockets. He says the problem is me. He doesn't say anywhere else he wishes he was living- he told me he was glad he's home- he told them all the "right stuff" at psychiatric hospital to get out.

OK, guys- lay it on me- if he was living in someone else's home, would he be pushing things like this? IOW, does he just need to be out of this home, with me raising him, or does he need Residential Treatment Center (RTC)?

 

[flutterbee]

I think he needs Residential Treatment Center (RTC). You're an easy target, plain and simple. If the problem is you then he doesn't have a problem, Know what I mean??

I also think he needs to go back to psychiatric hospital.

 

[klmno]

Thanks, Heather. I can't get him back in psychiatric hospital just yet- not on this. I guess I was just wondering if I should be pushing for him to get into foster care- because he would be better if he wasn't in my (our) home, or would he have a problem until some more extensive living environment was arranged- like Residential Treatment Center (RTC). Personally, I believe he would have a problem in any private residence. But I wanted to see if others thought that , too. Given that I know I'm biased.

I want to be fair with him- as far as if the problem really is me, I don't want him sent to a "punishing" environment. But, even if the problem is me, I would want him out of the home until we can get it worked out- and I would make every effort. If the problem is not me or our home, then I want to push for Residential Treatment Center (RTC). It might take a few days, but I'll just call cops again.

 

[flutterbee]

Doesn't cutting constitute a danger to oneself? I can't believe they wouldn't take him back for that.

It's hard for our kids to accept that they have an illness that they can't control. It's much easier to blame someone else - generally, the person they are closest to. Plus, he's at the age where everything is the parent's fault anyway. So, it's a double-whammy.

I think he needs an Residential Treatment Center (RTC) because he needs a structured environment with extensive monitoring and therapy.

 

[klmno]

They told me in Dec that it depends on the amount and extent of cutting- apparently, since it's so common these days, cutting on the arm (not at the wrist) is not enough to claim "acute". When I got him tdo'd in Dec for cutting, it was because he did it several times then told me "there's nothing left to cut but my wrist" and I considered that a threat for suicide. This will lead to him being tdo'd or arrested- I'll just wait until paperwork has floated around to a few people first. I do think he needs Residential Treatment Center (RTC)- I'm worried though because every place he's gone (psychiatric hospital, detention, anger management class) he's learned worse things he can do instead of being around kids who are encouraging NOT to do those things. Maybe that's where his own choices come into play. But he's so vulnerable to peer pressure and doing what those around him think is "cool", he'll do anything that another teen boy suggests or laughs about.

 

[klmno]

Well, I'm convinced now. He just cam e down to this room and told me he was sorry for ruining his life and my life and destroying the house. He told me he couldn't help himself- that if he didn't have cigs or something that all he wanted to do was hurt himself. I told him that we could get things turned around- that it takes effort, but we can do it. He grabbed more cigs and ran to his room. I checked the phone line and it was not working.

I went to his door and said I am not happy about him telling me bs just to get what he wants. He said he wasn't lieing- that he meant it. I said then give me the cigs and phone line (I found that he took it from my bedroom), he threw out the cigs. Then he said something about having razor blades. I told him to give me them and the phone line. He was upset (very) and said no, because I'd just call and have him sent back to psychiatric hospital. I told him I wouldn't call cops but I might call mental health but if he gave me blades and did nothing else to escalate things or hurt himself or me, I would not call cops tonight. He gave me blades (nicely) and phone line. I told him to leave his door cracked open and he did.

Then, as I got to the bottom of the stairs, he came out and as he was grabbing his hair, he said he told them everything at psychiatric hospital- embarressing stuff about liking a girl who cut off communication with him- and the psychiatric hospital discharged him anyway so obviously they don't care. (His words) He said that nothing helped. I told him we could discuss this with his therapist tomorrow and he just kept saying nothing works. Then he said he couldn't satnd going back to psychiatric hospital again that it made him want to just hurt himself more.

He said he needed a break from everything in life that he couldn't take it anymore. He said he had so much work from school to do that he'd never catch up and that he's ruined everything. The psychiatric hospital psychiatrist went from 100 mg tegretol to 400 mg/ per day in 4 days instead of titrating slowly, and difficult child had just started on it. Maybe this kicked him too far down into depression. Clearly, he needs more for medication stabilization. How do I prove that to the cynics?

I don't know any prof in their right mind that would not see that kid needs more help than family therapy or typical outpatient.- at least the out-patient we've been getting, so I assume it's typical. But, what can I do to convince these people? It seems like a lot of the problem is that I'm a single mom, so no one else is here in the house who can verify what is going on. I hurt for him- I swear I do- even when I am afraid of what he'll do next. I KNOW he needs help. If I called sw at psychiatric hospital tomorrow, do you think she can or will do anything?

 

[Big Bad Kitty]

Oh jeez I hope so. This is a nightmare. That poor kid. I wish there were something I could do.

 

[smallworld]

klmno, good morning. I hope you both managed to get some sleep.

This isn't about you. It's about your difficult child's mental illness, which I agree with Heather is hard for a young teen to accept, take responsibility for and cope with.

He definitely needs better medication management. Obviously, I'm not a doctor, but I'm not sure Tegretol is going to do anything for his current sx. He needs something for anxiety and depression, and Tegretol doesn't seem to target those sx.

I'm going to be the devil's advocate here. If you could locate a psychiatrist who is willing to see difficult child frequently (as in every week or every other week) and be very proactive about finding the right medication combo for your difficult child, he might not need Residential Treatment Center (RTC). That is what allowed us to keep our kids at home, but it wasn't easy and it took a while to stabilize them on their medications.

Hugs for your hurting mommy heart.

 

[timer lady]

klmno,

Please don't hit me but at this point the smoking is the least of your problems. If the tobacco is self calming give the boy a cigarette while you work out treatment options for difficult child. I'd place some caveats on the ciggys ~ no self harming & smoke with you, not in his room alone.

It really does sound like Residential Treatment Center (RTC) may be his next best option. I've run that gamut 3 times with wm, once with kt. More than some ~ to others I'm a novice with Residential Treatment Center (RTC). However, it made a huge difference when it came to regulating medications & helping my tweedles learn self calming skills. They also learned various techniques for self control & pulling back when they felt as though they would lose control.

The battles you choose when a difficult child is unstable should be well chosen & few & far between.

Do you have a crisis plan in place? A crisis team available to you? Another thought.

Gentle hugs to you this morning

 

[Janna]

klm,
I haven't been here in a while, so I'm obviously not fully up to date on your son, but I am so empathetic to what you're going through, because some pieces of your son sound like B, and some like D, and honestly, if I put those two of mine together, minus the depression and cutting, I've been there.
I agree with Heather and Smallworld that your son definately, definately needs better management. I would have big concerns with the psychiatrist not recognizing the seriousness of your son's cutting and self harm, the severe depression, and the fact that the medications do not seem to be working. Additionally, medication alone is not a cure, and although they are working on in home therapy and such, that may not be his answer fully either.
If I were you, I'd be searching for another psychiatrist. Also, I think that if you could find an Residential Treatment Facility (RTF) with a reputable psychiatrist and a good theraputic component, you could make some strides. When D was in Residential Treatment Facility (RTF), they made alot of medication changes over time. And, they had alot of therapies (equine, art, horticultural, individual, family, etc). You may not find something in your town. B is in Residential Treatment Facility (RTF) 2 hours from me, but that's where he had to go to get what he needed. Residential Treatment Facility (RTF) is never an easy decision. Some children are able to be stabilized at home. But, some children aren't, and that's a decision you need to make. You won't get to a psychiatrist and get a pill or two and see an instant result. Even if you get him on mood stabilizers, say, you're looking at a 6-8 week time frame for possible stabilization. Can you hang in there with him for that length of time? It's not even all about him. It's about you, too.

B is really not able to live here. It's funny you mentioned foster care, because we've gone that route, too. B has been in several. Residential Treatment Facility (RTF), too. He has always done well outside of this home, and for the life of us, we have never been able to figure out why. He receives praise and nothing but good words from almost every person that has worked with him, but when he comes here, things go downhill. At this point (he's 17) we have decided he just cannot live here.

You can do Residential Treatment Facility (RTF), too, and then do a step down program. You want to find out if any potential Residential Treatment Facility (RTF) would have this type of intervention. Where, when your son is done with the Residential Treatment Facility (RTF), he could go to foster care with a goal of reunification, and make short visits home (say, every other weekend), increasing visits, until you are all comfortable with him coming back.

But, you will need a psychiatrist in your corner. Did you check into MH/MR like I was saying on another post? Look in your blue/pink pages of your phone book for Mental Health services, or look on NAMI's website. You need someone that is going to be able to put him in someplace, and you don't have that in your corner.

I hope things get better today. I am very sorry you are dealing with this. I can really relate.

 

[ML]

I agree that he needs so much more help than what he is getting and I do think Residential Treatment Center (RTC) for a period of time makes the most sense. You must be exhausted. Hugs, ML

 

[janebrain]

Hi,
just wanted to say I agree with Timer about the cigs. They are a powerful addiction, I would not want to fight that battle when he is so unstable. I would let him have the cigs, they probably are a self-calming help for him.

I feel for you, you have had such an uphill climb!

Jane

 

[TerryJ2]

Klmno, sigh. I was waiting for this. I knew he wasn't stable, just from your notes.

An Residential Treatment Center (RTC) sounds like a good idea.

I absolutely hate smoking, but if it calms him down, I'd say go for it. He is way overwhelmed, catastrophizing, and totally unable to cope. Of course, there's always the idea that if you give him cigs, he'll up the ante and want something else.

I have a cartoon of an elephant on my wall, and the words say, "How do you eat an elephant?" He needs to know that you do it in tiny, bite-size chunks. He is so totally overwhelmed he doesn't know where to begin. I can't believe he hasn't addressed that in therapy. It is so hard, as a teen, to digest so many normal emotions and new experiences, but when you don't have the tools, and your brain won't allow you to process properly, it is totally magnified. Poor kid.

Poor you.

I'm glad that he gave you the cigs, the phone and the razors. He CAN do it. It's going to be a long process.
I wish I could be of more help, but at the rate I'm going, I suspect I will be in your shoes sooner rather than later.

Many, many hugs.

 

[klmno]

Thank you all so much. Your understandding of what I'm going thru and difficult child is going thu is remarkable and very much appreciated.

The last time I talked to his psychiatrist about this sort of thing (instead of strictly medications, letter for county help, etc), psychiatrist said "well, it could all be manipulation". When difficult child did the stuff last night until he got the cigs, I thought it was just manipulation, too, but after the other actions and wordss, I don't- at least not all of it. It sunds and looks to me like he is really struggling, even though at some times he is manipulating me to get what he wants, he's battling not to do that at other times.

But, as I mentioned on another thread, anytime difficult child is symptommatic, psychiatrist acts like its ODD on top of other things instead of that we need better treatment for the "real" issues. He has always been that way and it took me a long time to realize why I felt like I was getting conflicting messages from him, and tdocs- they are that way too. Now, I just think it's psychiatrist's philosophy and the nature of tdocs. I do understand and agree that difficult child can learn to control and manage and prevent a lot of things that he can's right now, but I don't think he's going to learn that by punishment being the sole or primary means of "teaching".

SW, I had no idea that there were psychiatrists around who would see a patient that often and work that closely with them to get medications right. If I could get necessary supports in place to help with things (this is not going to be done by just an in-home therapist), I would have no problem with difficult child staying home. There seem to be a lot of variables with that though-like, what if we can't get it, if we can get it and end up with a cm who has no understanding of BiPolar (BP) or just wants to focus on a behavior contract, etc.

Anyway, at this point, I'm begging to see if I can get anything for him/us. Whatever I can get does not appear to be my choice and according to that funding coordinator, the only way for me to get any supports (in or out of home) and have any input, is to get in front of the county team without a specific therapy being recommended or ordered by anyone first. I've tried to get referrals like that and psychiatrist's is, therapist's is somewhat, but psychiatric hospital's just said "intensive in-home services". I'm hoping that with the other 2 letters, maybe the judge can see that it isn't mst. If it was mst being recommended, they would have said that.

 

[susiestar]

I am so sorry things are going this way so soon after the psychiatric hospital discharge. I think he was released too soon, and was NOT stable. I also wonder what the tegretol is supposed to do. Esp as they raised the dosage so quickly.

I do agree that if cigs will allow him to self calm, make that a basket D issue. Simply because it is such a big challenge to quit. and if you smoke, having the smell around will make him crave cigarrettes. It will be much easier to deal with the cigarrette issue when he is stable.

I worry about the phone line. Do you have a cell phone, even just an old one with no contract? because you can call 911 from any cell phone that has a battery charge - it is a federal requirement. Him tkaing hte phone line is an attempt to control you and keep you from getting help if he hurts himself or you. This is serious. if you don't have a cell phone you may want to get one of the pay by the minute phones for emergencies.

Sadly, cutting is no longer something that qualifies for psychiatric hospital admission unless the person gets infected or cuts WAY too deep. It is seen as a way of handling emotional pain, not as a suicide attempt. I can remember crying when the insurance co told me this. I then got a box of alcohol swabs, the ones used for shots? at walmart for about $1. I sat with Wiz and told him if he was going to cut he was going to use some basic precautions so that he did not end up with an infection. I had to talk to him about cleaning the knife/razor blade ESP if another person had used it and they were "sharing". I told him if I learned he was sharing a razor blade with someone that he would have to go through all SORTS of medical tests as you can share HIV, hepatitus, almost ANY disease through sharing blood. I taught him to use the alcohol swabs to clean the skin, the knife, and to clean up after himself so his siblings were not exposed to blood. I know he used them while cutting. Sadly, the sting of the alcohol was not a deterrent. I KNOW you don't want to encourage cutting. But if youcannot make him stop, you may want to think about teaching how to avoid infections from it.

He would be acting this way no matter where he was, even at psychiatric hospital if he didnt' work so hard at telling them what they wanted to hear. Your relationship may be somewhat "enmeshed", but I honestly don't think you are the cause of his behavior. And I don't think he would be able to honeymoon for long at a "long term" psychiatric hospital or at an Residential Treatment Center (RTC).

I am so sorry the "experts" keep wanting to blame you for difficult child's problems. It is unbelievable the lengths these people are going to in order to NOT provide services to your son. Actually, I find the lengths the "system" is going to in order to let your son fall through the cracks to be morally reprehansible. Esp on the part of the therapist and psychiatrist who told YOU that he needed Residential Treatment Center (RTC), but refused to tell the "system" and the PO that he needs it.

I am so sorry. And so worried about both of you. I am praying that SOON the system starts working properly for you and gets your son the help he needs.

 

[smallworld]

As I've said before, J's psychiatrist doesn't like to call his behavior "manipulation" or "ODD." He says it's too hard to figure out what the child can and can't control, and it doesn't matter anyway. What does matter is that the behavior is a maladaptive coping skill that needs addressing with medications, therapy, interventions, etc.

 

[klmno]

Esp on the part of the therapist and psychiatrist who told YOU that he needed Residential Treatment Center (RTC), but refused to tell the "system" and the PO that he needs it.

I don't know if it happens everywhere, but it seems to be very common here for everyone to change recommendations to what they think they can get approved. GAL, sd, tdocs, etc, have all done this. While I understand the position of not wanting to waste an opportunity to request something that has no chance of getting approved, if it is not made clear what is really needed, if gives me no opportunity to get it, justification to appeal a decision, and does not let higher ups in the county know that there are many kidss that need "xxx" and the county doess not make it available. I brought that up while tesstifying to the judge last year, too, because the GAL had refused to ask the judge for something difficult child needed simply because she said the judge wouldn't/couldn't order it. I thought she should have let the judge know what was needed and recommended anyway. That way, at least the judge would know that difficult child was not getting what others thought he needed, instead of potentially ending up in a situation where it appears that difficult child got what was recommended but it failed leaving her to think it would be pointless to try anything further.

 

[klmno]

I like J's psychiatrist. I wish we were close enough to see him/her on a regular basis. I have started asking around about another recommended child/adolescent psychiatrist, but so far can't find one that has openings, except the one at the place I had the MDE done and she's not the same on appts outside of MDE. I wouldn't want to stick with her as a regular psychiatrist without having a therapist there that was taking the lead in treatment.

 

[CrazyinVA]

I loved Youngest's therapist, but she is a female and I'm not sure she is taking new patients. My favorite thing about her was that she put up with NO BS. She was also incredibly proactive in helping me with crisis plans at home. The thing about manipulative behavior.. and both my difficult children are queens of manipulation .. is that it can still end up being quite dangerous. I was told to call Youngest on every single threat, so she learned I would take them all seriously. If that meant constant calls to 911,so be it. I loved Youngest's psychiatrist too, a nd still see her as my own psychiatrist. The therapist and psychiatrist worked together constantly on Youngest's issues. therapist saw Youngest weekly, sometimes twice weekly when things were really bad. psychiatrist was monthly, as long as there were supports in place during more difficult times.

If todays behavior continues to escalate, I wouldn't hesitate to call crisis. A call to psychiatrist might be in order too, and tell the receptionist it is an emergency .. that your difficult child was discharged yesterday and is already escalating dangerously.

Hugs.

 

[KTMom91]

No advice or suggestions...just hugs and strength. I'm so sorry he's escalating already.